Lenghtening only one leg at a time, consecutively, with a break between.

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It's a discussion to be had, wheels.

The most severe - I believe (also not a doctor) - form of complication more typical of external methods also isn't discussed much here. Osteomyelitis. I also don't have a quote at hand for it being more prevalent in external methods, but I do recall reading that.

I believe it is hard to treat if not caught early.

Here's an overview from pediatric external fixator cases. Full paper. Great for learning about pin-site care, but it also delves into osteomyelitis.

From prevention of pin-tract infection to treatment of osteomyelitis during paediatric external fixation.

(PMID:27848193 PMCID:PMC5145837)

Quote from: AbstractPin-tract infection (PTI) is the most commonly expected problem, or even an almost inevitable complication, when using external fixation. Left untreated, PTI will progress unavoidably, lead to mechanical pin loosening, and ultimately cause instability of the external fixator pin–bone construct. Thus, PTI remains a clinical challenge, specifically in cases of limb lengthening or deformity correction. Standardised pin site protocols which encompass an understanding of external fixator biomechanics and meticulous surgical technique during pin and wire insertion, postoperative pin site care and pin removal could limit the incidence of major infections and treatment failures. Here we discuss concepts regarding the epidemiology, physiopathology and microbiology of PTI in paediatric populations, as well as the clinical presentations, diagnosis, classification and treatment of these infections.

Some further reading that incorporates DO in the text, from 1996.
https://europepmc.org/abstract/MED/8948280
(Subscription required for the full text.)

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interesting!

so the chance for PTI is higher with hybrid fixator (like pili's) than ring fixator (tsf) ?

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Ah, I thought you were considering unilateral internals. Which is why I recommended Stryde instead, because then the prices would be somewhat similar and justifiable.

I'm doing external tibias and femurs with doctors Solomin and Kulesh as we speak (diary link in signature), so I'm not entirely biased. That being said, I still place Precice Stryde at the pinnacle of limb lengthening methods for now.

But hey, if you've got the money and time, go for it! No question unilateral will be more comfortable. I'm just the type to think if I'm going to suffer, I'll suffer all the way to get it over with, but I know not everyone is like me.

I also quit my job to do this, so my priorities and requirements are different. But believe me, this journey itself is a full-time job itself, so do anticipate a drop in productivity either way.

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Quote from: Android on July 07, 2018, 09:11:16 AMAh, I thought you were considering unilateral internals. Which is why I recommended Stryde instead, because then the prices would be somewhat similar and justifiable.

I'm doing external tibias and femurs with doctors Solomin and Kulesh as we speak (diary link in signature), so I'm not entirely biased. That being said, I still place Precice Stryde at the pinnacle of limb lengthening methods for now.

But hey, if you've got the money and time, go for it! No question unilateral will be more comfortable. I'm just the type to think if I'm going to suffer, I'll suffer all the way to get it over with, but I know not everyone is like me.

I also quit my job to do this, so my priorities and requirements are different. But believe me, this journey itself is a full-time job itself, so do anticipate a drop in productivity either way.

It's not just the suffering. What about life and death? Doing bilateral or worse quadrilateral means you have more chances to die.

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Quote from: Bruce Wayne on July 07, 2018, 02:18:49 PMIt's not just the suffering. What about life and death? Doing bilateral or worse quadrilateral means you have more chances to die.

That all should be true, at least on a logical level. The problem is time.

The less pin-sites you have to care of, the more manageable they and their infections are (or should be). The point about your body not having to divide its resources, so it can heal one leg more efficiently might be true, too (we did discover different caloric intakes per bone break). The less bones you have to ream, the less emboli should get released into your bloodstream. Though, I'm pretty certain they still do get released just from fractures and osteotomies/corticotomies.

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Quote from: myloginacc on July 07, 2018, 03:05:35 PMThat all should be true, at least on a logical level. The problem is time.

The less pin-sites you have to care of, the more manageable they and their infections are (or should be). The point about your body not having to divide its resources, so it can heal one leg more efficiently might be true, too (we did discover different caloric intakes per bone break). The less bones you have to ream, the less emboli should get released into your bloodstream. Though, I'm pretty certain they still do get released just from fractures and osteotomies/corticotomies.

I was also thinking about my pin-site point in this post here. It certainly would be more manageable in terms of pin-site infections (half the pins/wires, half the locations for possible infection)... for that one leg.

However, I wonder if it'd really be better for the body to go for another huge dose of antibiotics when you finally get to the other leg? (If the interval between the surgeries was big... because you wanted to keep working, or something to that effect.)

There may be bacteria more common to the LL process (as one of the paper above indicates), and if some were hidden inside the other leg's bone, they could have, maybe, developed resistance to the antibiotics. That could become a huge problem when the external fixator on the final leg would allow them into other parts of the body. This is all layman theorizing by my part, though. It could be complete nonsense.

I'd say it's worth asking about, at least.

A question for a serious doctor, at least among those interested in unilateral lengthening followed by another lengthening in the more distant future.